If you have a personality disorder you may also have other mental health problems, such as depression, anxiety, panic disorders, eating disorders, deliberate self-harm, substance misuse, and manic depression. It is not known if the personality disorder causes these other problems or if they simply exist side by side and are unrelated.
It can be very difficult to diagnose personality disorders because of other mental health problems, which often hide the personality disorder. It is also possible to misdiagnose someone as having a personality disorder if they have a syndrome with similar symptoms e.g. post-traumatic stress syndrome or Asperger's syndrome.
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Two different classification systems are used for personality disorders:
Diagnostic criteria: DSM classification system
Diagnostic criteria for personality disorder refer to behaviours or traits that are characteristic of the person's recent and long term functioning since early childhood. Personality disorder describes a constellation of behaviours or traits that cause either significant impairment in social or occupational functioning or subjective distress.
Diagnostic criteria: ICD classification system
Diagnostic criteria include variety of conditions which indicate a person's characteristic and enduring patterns of inner experience (cognition and affect) and behaviour(s) that differ markedly from a culturally expected and accepted range.
According to the DSM system, there are three main clusters of personality disorder.
Cluster A:
Cluster B:
Cluster C:
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At present very little is known about the long term benefits of different forms of treatments for personality disorders. This is because very little research has been undertaken. The research that has been undertaken to date suggests that most forms of personality disorder may be treatable or manageable, especially the more moderate forms, but no single treatment or management strategy will be effective in all cases.
Personality disorders may be difficult to treat because they involve lifelong, pervasive attitudes and behaviours and because people with personality disorders often have other mental health problems. When a treatment is seen to fail it is often the patient who is blamed for not fitting the programme rather than the service admitting that it has not met the individual's need.
In the UK treatment for personality disorders varies considerably, depending to a large extent on whether people are in a general NHS setting, an in-patient psychiatric unit, special hospital or in the prison system. The availability of appropriate resources including qualified staff, therapeutic environments and management support for innovative treatments is also a major issue.
Medication (pharmacological treatments)
Short term treatments may include anxiolytic or neuroleptic drugs which are given for short periods or at times of severe stress. Long term treatments may involve the use of neuroleptics which can be helpful in cases of paranoid and schizotypal personality disorders. However it is possible that the medication is being used to control risk and stress, rather than having any long term impact on the personality disorder itself.
Psychodynamic treatment
This treatment emphasises personality structure and development. It aims to provide insight for people allowing them to understand their feelings and to find better coping mechanisms. This approach has had limited success and is likely to be less successful for those with addiction and/or antisocial personality disorder.
Cognitive and behavioural therapy
Cognitive and behavioural therapies cover a wide range of treatments such as Cognitive Therapy, Dialectical Behaviour Therapy, Interpersonal Psychotherapy and Cognitive Analytic Therapy. Most cognitive behavioural approaches address specific aspects of thoughts, feelings, behaviour or attitude, and do not claim to treat the entire personality disorder of the person. Research suggests that there are some short term benefits to these approaches but more research is required into the long term benefits.
Therapeutic Communities
The Therapeutic Community (TC) approach involves living in a therapeutic community for several months. Engagement in therapy is voluntary and responsibility for the day to day running of the TC is shared between patients and staff. Members of the TC are encouraged to talk about their feelings, and particularly their feelings about each others' behaviour. This encourages them to think about the affect of their own behaviour on other people. The results of TC are still under scrutiny.
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Written in 2003
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